Provider Demographics
NPI:1275337164
Name:ADAMS, SHANNON NICOLE (IPDH)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICOLE
Last Name:ADAMS
Suffix:
Gender:
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 JOANS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2664
Mailing Address - Country:US
Mailing Address - Phone:207-356-2155
Mailing Address - Fax:
Practice Address - Street 1:1460 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5790
Practice Address - Country:US
Practice Address - Phone:207-356-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH2852124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist